Bed Management Policy and Procedure
1
Introduction
1.1 The Trust is committed to service user being cared for in the community and being
offered the least restrictive alternative.
1.2 Any potential admission must be offered a face to face gate keeping assessment by
the Intensive Home Based Treatment Team prior to admission, whenever possible.
1.3 Service users will normally be admitted to an age and speciality appropriate vacant
bed within this district.
1.4 This policy intends to ensure that the Trust meets the clinical need and safety of all
service users requiring admission.
2
Objectives
2.1
To provide a safe, practical, solution focused approach to bed management
issues.
2.2
To describe how the bed base can be best used taking account of:
2.2.1 Safety of Service Users
2.2.2 Clinical Need.
2.3
The policy covers all the Trust’s Mental Health bed bases (Barnsley see 2.4).
2.4
In recognition of the different commissioning arrangements for Barnsley BDU, as
compared with West Yorkshire BDU’s, it is essential that the bed capacity at
Kendray Hospital (including PICU) is prioritised in order to accommodate Barnsley
residents. In general, a minimum of a male, female and PICU bed will be made
available to accommodate local BDU service needs. Decisions to admit are
clinical decisions, ensuring that local resource is available to meet local demand,
in accordance with Commissioning demands. (This point to be verified at EMT).
2.5
The Trust will operate an “early warning” system to alert the relevant people
regarding the lack of or low availability of beds. This will involve timely
communication between bed managers or their equivalent in the different BDU’s
and the Acute Service Managers and the On Call Managers out of hours. This will
enable escalation where appropriate and it will be the responsibility of each BDU
to clearly describe this process within their own area. Bed availability is always
fluid and it is accepted that assessment of the situation will need to take place
continuously throughout each shift.
Concerns about capacity will be communicated to the Acute Services Manager
and contingency plans discussed and agreed. This will include discussion with
other BDU’s within the Trust regarding their capacity for admission and to identify
if Trust wide action is required, e.g. block booking of additional beds from outside
of the organisation. Agreement of funding for block booking will sit with the District
Director or their nominated Deputy.
Chair: Ian Black
Chief Executive: Steven Michael
The Acute Services Manager will ensure that any significant issues and agreed
contingency plans are communicated to the on call manager before the end of the
working day.
Out of hours, Bank Holidays etc., the on call manager will be informed of any
significant bed management issues in lieu of the Acute Services Manager.
3
2.6
To provide a clear framework that supports decision making in and out of hours
around potential bed management issues.
2.7
To ensure clear and open communication with all involved in the process. Up-todate clinical information and risk assessments should be available irrespective of
where the service user is admitted.
Bed Usage
3.1
Leave beds
In general leave beds can be used, however it is the duty of the Consultant and
the Ward Manager (or their nominated Deputy) at the point of authorising leave to
determine the likelihood of the risks of leave breaking down. When a high risk of
early return is identified, the bed may be protected and cannot be used for further
admissions. This will be considered predominately for first periods of short term
leave from the ward or where there are concerns that the individual’s social
circumstances may not be able to support the agreed period of leave. This will be
clearly evidenced and the rationale for the decision to protect the bed must be
clearly documented in the notes and the appropriate form completed for audit
purposes.
The decision must be widely communicated and reviewed
appropriately.
3.2
AWOL beds
AWOL beds can be used.
documented.
3.3
The rationale for not doing so must be clearly
3.2.1
In hours the decision will be made by the Inpatient Consultant and Ward
Manager (or their nominated Deputy) in consultation with the MDT.
3.2.2
Out of hours the decision will be made by the On Call Consultant in
consultation with the nurse in charge of the ward.
PICU beds
Admission to PICU beds should be within the PICU Operational Policy except in
exceptional situations when the only available out of area bed is in a PICU Unit. In
this case the patient will be admitted and the decision will be based on the same
principles of clinical need and risk. This will include the risk of admitting such
patients to a PICU bed regardless of their Mental Health Act status.
Chair: Ian Black
Chief Executive: Steven Michael
Any service user admitted to PICU in these circumstances should receive:

1:1 Observations for the duration of their stay

Full information about access and egress in a PICU environment

Removal to an appropriate bed within 72 hours. Where this is not achieved,
an exception report will be provided to the Acute Services Manager and
copied to the Ward Manager. The report will be completed by the Bed
Manager in the service users host BDU.
Such admissions will be recorded on DATIX as a red incident in the first
instance as a potential breach of standards may have occurred. The incident
must be reviewed and graded appropriately by the relevant clinical lead within
24 hours. The service user will be a priority for return to a suitable
environment in line with the principle of least restrictive alternative.
3.4
CTO (Community Treatment Order) Beds
Beds that are identified for CTO recall can be excluded as there is a legal
obligation under the Mental Health Act to provide safe recall conditions
3.5
Gender Specific issues
The Trust is committed to providing gender specific bedroom accommodation in
line with EMSA requirements. Decisions to use gender specific beds to
accommodate admissions of the opposite sex must be authorised by the
Consultant and Ward Manager (or their nominated Deputies) and appropriate
measures put in place to maintain the privacy and dignity of service users until a
bed in a gender specific area can be made available.
If a patient is admitted to a bed which is not in the gender specific area it will be
covered by the EMSA Policy and according to this policy would be recorded on
DATIX in line with relevant Commissioner requirements.
3.6
Absence of beds
There will be some exceptional situations when all reasonable efforts have been
made to find a bed internally or out of area from other providers and IHBT is not a
viable option as an emergency measure, the service user should be admitted to a
ward in their own locality and made as comfortable as possible until a bed is
available. Service users and their families should have these circumstances fully
explained to them prior to admission by the team who have made the decision to
admit. Observations must be implemented to reflect any ongoing risks and the
incident recorded on DATIX and graded red in the first instance as a potential
breach of standards may have occurred. The incident must be reviewed and
graded appropriately by the relevant clinical lead within 24 hours.
Every effort must be made to ensure that the quality of accommodation offered is
carefully considered and that the privacy and dignity of the service user is
protected at all times. Each Ward Manager is responsible for formulating a
Contingency Plan for their Ward that can be initiated should this exceptional
circumstance occur.
Chair: Ian Black
Chief Executive: Steven Michael
3.7
4
Where a service user is admitted outside their host BDU, it is expected that they
will be returned as soon as possible to their host BDU. This should be discussed
with the service user on admission and included in their care plan.
Staffing
Whenever a service user is admitted the nurse in charge in consultation with the
admitting doctor (and their senior if necessary) will decide on any additional staffing
depending on service user needs at the time.
5
Bed Management Procedure
If admission is required and a vacant bed is not available in the host BDU, the process
outlined below should be used.
Chair: Ian Black
Chief Executive: Steven Michael
No vacant beds in host BDU
Leave Beds in Host BDU
Protected / Not Available for Use
Available for use
Seek Trustwide Vacant Beds
(Geographically closest to SU first)
Admit (Ward Level Plan to
manage additional admission)
Vacant beds
No Vacant beds
Admit
Leave Beds

Available for use
Protected/Unavailable



Consider use of Non-Gender Specific Beds & EMSA
implications
Seek out of Area Bed
Preferred Providers (see appendix)
Any other provider (see appendix)
Admit (Ward Level plan to manage
additional admission)



Chair: Ian Black
Chief Executive: Steven Michael
Consider Use of AWOL Bed
Consider vacant PICU bed (regardless of MHA status)
If all other options have been exhausted, admit to Host Ward
until bed available.